Six months into MACRA rollout, docs are still unprepared

More than halfway through the first year of the rollout of the Medicare Access and CHIP Reauthorization Act, the majority of medical practice leaders still are not ready to comply with the law, according to a survey by American Medical Association and consulting firm KPMG.

The revelation, outlined in a report released Wednesday, is based on the responses from 1,000 physicians who have been involved in practice decision-making related to MACRA. The survey found that fewer than 1 in 4 physicians interviewed were prepared to meet statutory requirements this year. The revelation could mean that many will face a financial penalty in 2019, which is when 2017 compliance will be measured.

Providers' lack of preparedness for MACRA has been a longstanding concern, but the AMA/KPMG report drilled deeper into the knowledge gaps, according to Larry Kocot, principal at KPMG's Center for Healthcare Regulatory Insight.

The survey found that that 51% of the doctors responding were only somewhat knowledgeable about MACRA and its new quality reporting system, the Merit-based Incentive Payment System, or MIPS.

In addition, 90% felt the reporting requirements were somewhat or very burdensome, given the time it would take to comply with MIPS requirements. The physicians also raised concerns about understanding requirements, how MIPS performance is scored, and the cost required to accurately capture and report performance.

Unsurprisingly, the report found that those without experience with value-based reporting systems were most likely to find MIPS requirements burdensome and feel less prepared for long-term financial success. It also found that respondents in a large practice with 50 or more physicians were more likely to feel prepared.

A CMS spokesman did not respond to a request for comment. However, a week before the AMA/KPMG report was released, the agency announced that more small providers would be exempt from MACRA.

Physician practices with less than $90,000 in Medicare revenue or fewer than 200 unique Medicare patients per year would be exempt under the new draft rule released June 20. The move will exclude about 834,000 more clinicians from complying with the quality reporting program under MACRA. The original threshold was $30,000 or fewer than 100 Medicare patients.

The move was a step in the right direction, according to Kocot.

"Penalizing these providers wouldn't make them learn this any faster," he said.

The vast majority of physicians surveyed, 83%, said they needed more educational opportunities to understand MIPS requirements. Specifically, they wanted to know more about reporting requirements, how compliance with the quality system is scored and potential financial impact of the system.

In conjunction with the findings, the AMA has developed a resources guide to help physicians work toward compliance. Clinicians will be able to view a step-by-step video on minimum reporting requirements to avoid a penalty in 2019 and a payment model evaluator that offers a brief assessment of where a practice stands.